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ObjectiveTo investigate the current landscape and hotspots on researches about treatment of prolonged disorder of consciousness (pDOC) in the recent five years, and forecast the trends. MethodsLiterature about treatment of pDOC was retrieved from the Web of Science Core Collection database, from January 1st, 2019, to June 7th, 2023. The data were analyzed with CiteSpace 5.8.R3 to create knowledge maps for authors, countries, institutions, keywords, references, co-cited authors and co-cited literature. ResultsA total of 411 articles were included. Aurore Thibaut was the most influential author, Belgium was the most influential country, and Harvard Medical School was the institution with the most publications. The researches focused on neuromodulation, prognostic assessment and care, and management of swallowing function. The neuromodulation techniques mainly included transcranial direct current stimulation, repetitive transcranial magnetic stimulation, deep brain stimulation and transcutaneous auricular vague nerve stimulation. In the coming years, the researches trended to explore neuromodulation and mechanisms of consciousness recovery, and the main neuromodulation techniques might be deep brain stimulation and transcutaneous auricular vague nerve stimulation. ConclusionThe researches about treatment of pDOC are increasing, mainly focusing on neuromodulation, prognostic evaluation, nursing care, and training for swallowing function. More researches would focus on neuromodulation and mechanisms for restoring consciousness.
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Objective:To explore the safety and efficacy of the minimally invasive treatment of unstable pelvic fractures with the blunt head technique of Kirschner wire and 3D-printed external template technique.Methods:A retrospective study was conducted of the clinical data of 21 patients with unstable pelvic fracture who had undergone minimally invasive treatment at Department of Orthopaedics, Union Hospital from May 2016 to July 2018 using 3D-printed external templates and the blunt head technique of Kirschner wire. There were 7 males and 14 females with an age of 43.6 years (from 19 to 65 years). According to the Tile classification, there were 3 cases of B1, 7 ones of B2, 6 ones of C1 and 5 ones of C2. The intraoperative fluoroscopy, operation time, postoperative fracture reduction and functional recovery of the pelvis at the last follow-up were recorded.Results:The 21 patients were followed up for an average of 16.3 months (from 12 to 24 months). A total of 33 wires were inserted in the 21 patients, including 15 S 1 ones and 18 S 2 ones. The intraoperative fluoroscopy ranged from 13 to 27 times, averaging 21.8 times. The operation time ranged from 65 to 130 min, averaging 88.6 min. The anterior subcutaneous internal fixation was used to fix the anterior ring in 9 patients. No vascular injury occurred during the operation. By the Matta criteria, the postoperative fracture reduction was assessed as excellent in 14 cases, good in 5, and fair in 2, giving an excellent to good rate of 90.5% (19/21). By the Majeed scoring system, the pelvic function at the last follow-up was assessed as excellent in 10 cases, good in 8, and fair in 3, giving an excellent to good rate of 85.7% (18/21). Lateral femoral cutaneous nerve injury occurred in 2 patients but was recovered by the 3-month follow-up. No other complications were follwed up. Conclusion:The minimally invasive treatment of unstable pelvic fractures with the blunt head technique of Kirschner wire assissted by 3D-printed external templates is safe and effective, showing advatages of reduced fluoroscopic frequency and operation time.
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Objective:To summarize the clinical characteristics and prognosis of acute hyperextension spinal cord injury (SCI) in children, and to provide some recommendations for the treatment and prevention of this disease.Methods:Reviewed the data of children of SCI after sustained or repeated hyperextension of the spine at Wuhan Union Hospital and Wuhan Children's Hospital from September 2010 to September 2020. According to the American Spinal Injury Association impairment scale (AIS grade), the patients were divided into complete SCI group and incomplete SCI group. The age, symptoms and evolution after injury, neurological level of injury, imaging data, laboratory examination data, prognosis and complications of the two groups were analyzed. Retrospectively summarize the characteristics of this type of injury.Results:Forty-four cases of acute hyperextension SCI in children were included. Their age ranged from 3 to 10 years old, 95% of them were under 8 years old and 95% of them were female. There was no significant difference in age at injury and time of dance training between children with complete SCI and incomplete SCI. Back and leg pain, lower limb weakness or paresthesia, and rapidly progress to complete or incomplete SCI in a short period were typical symptoms. All blood test results anddiagnostic analysis of cerebrospinal fluid were unremarkable or negative. There was no fracture or dislocation in the whole spine. Magnetic resonance imaging showed a longitudinally extended intramedullary high-intensity signal in the thoracolumbar spinal cord. Complete SCI accounted for 60% of all cases, and the prognosis was poor with spinal cord atrophy and various complications.Conclusion:Children younger than 10 years old after sustained or repeated hyperextension of the spine may suffer acute hyperextension SCI. Children with complete SCI have poor prognosis and serious complications. Therefore, prevention of this type of injury is the best strategy.
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OBJECTIVES@#To explore the effect of etomidate on the neuronal activity of ventral thalamic reuniens nucleus and the underlying mechanisms.@*METHODS@#Whole-cell patch clamp method was used to explore the effect of etomidate on the activity of ventral thalamic reuniens neurons in the acute brain slices obtained from 4-5 weeks old C57BL/6J mice. The electrophysiological characteristics of ventral thalamic reuniens neurons were recorded in the current clamp mode, and then the effects of etomidate (0.5, 2.0, 8.0 μmol/L etomidate groups) and intralipid (intralipid group) on the discharge frequency and membrane potential of ventral thalamic reuniens neurons were recorded. During the experiment, the ventral thalamic reuniens neuron firing rates (RNFRs) were recorded as F@*RESULTS@#In the intralipid group, there was no significant difference among the F@*CONCLUSIONS@#Etomidate can inhibit the activity of ventral thalamic reuniens neurons in concentration-dependent manner, and which is reversible. Etomidate with sub-anesthetic concentration inhibits the activity of ventral thalamic reuniens neurons via targeting the GABA
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Animals , Mice , Etomidate/pharmacology , Mice, Inbred C57BL , Neurons , Patch-Clamp Techniques , Receptors, GABA-AABSTRACT
Objective:To observe the effect of combining scalp acupuncture with feedback training on muscle tone, motor ability, plantar pressure distribution and joint range of motion of stroke survivors with lower limb spastic paralysis.Methods:A total of 212 stroke survivors were randomly divided into a combination group ( n=70), an exercise group ( n=70) and a scalp acupuncture group ( n=72) according to a random number table. All of the patients received routine medication and 120 minutes of rehabilitation training six days a week for 8 consecutive weeks. The rehabilitation training included guidance on good posture, posture change training, balance training and gait training. The scalp acupuncture and exercise groups were additionally provided with 40 minutes of scalp acupuncture and lower limb intelligent feedback training, while the combination group was given both. Muscle tension, balance and lower extremity movement were quantified before and after the training, and a gait evaluation system was used to detect the plantar pressure distribution on the affected side and the range of motion range of the lower limb joints during walking. Results:After the treatment, significant differences were observed in the average modified Ashworth scores, modified Berg scale scores, Fugl-Meyer lower extremity ratings and modified Barthel Index scores compared with before the treatment. The average scores of the combination group were then significantly better than those of the other two groups. The average load bearing ratios of the affected toes, metatarsal bones Ⅰ-V, medial arch, external arch, medial heel and external heel had improved significantly in all of the groups, with the improvement of the combination group again significantly greater than those of the other groups. The same pattern of improvement was observed in the groups′ average pelvic rotation angles, hip flexion angles, knee flexion angles and ankle dorsiflexion angles.Conclusion:Combining scalp acupuncture with intelligent feedback can significantly improve lower extremity functioning after a stroke. That should improve performance in the activities of daily living of stroke survivors.
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Objective:To evaluate the safety and efficacy of endoscopic resection in the treatment of patients with primary non-ampullary duodenal early cancer.Methods:A total of 20 cases with primary non-ampullary duodenal early cancer receiving endoscopic resection were collected from Jan 2015 to Dec 2019 at the Department of Endoscopy, the First Affiliated Hospital of Shandong First Medical University.Results:The size of lesions ranged from 0.3-2.5 cm (0.9±0.5)cm.The size of removed membrane samples ranged from 1.5-3.5 cm (2.5±0.7)cm. The edges were all negatiue pathologically. Duodenal perforation occurred in 2 cases, and all were successfully clipped by endoscopy. The follow-up time was from 4-42 months (20.4±11.4)m and no recurrence was found.Conclusion:Endoscopic resection is a safe and effective method for primary non-ampullary duodenal early cancer.
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Objective:To explore the feasibility, safety and clinical efficacy of using the self-developed acetabular posterior wall and column integrative anatomical plate to treat various types of posterior wall/column fractures.Methods:Between January 2016 and January 2019, 21 patients involving acetabular posterior wall and/or column were treated with the novel acetabular posterior wall and column integrative plate, the data were collected and retrospectively analyzed. There were 11 males and 10 females, with an average of 48 years old (range, 18-65 years old). According to the classification of AO/OTA, there were 6 simple fractures, 9 comminuted fractures, and 6 associated with joint surface compression of posterior wall; and there were 16 simple acetabular posterior wall fractures and 5 cases associated with acetabular posterior column fractures. Before operation, the CT data of each patient was collected and imported into Mimics software to reconstruct and print a 3D model of pelvis and injured and mirrored side to simulate operation. All patients were treated with a single Kocher-Langenbeck approach for posterior acetabular fractures, and fixed with the novel integrated anatomical plate after satisfactory reduction was achieved. Matta score was used to evaluate the quality of fracture reduction, and the modified Merle D'Aubigné-Postel score was adopted to evaluate functional recovery of hip joint.Results:21 patients involved in this study, the average time of plate insertion after successful reduction was 20 min (range, 15-30 min); the mean time of operation was 180 min (range, 90-300 min); the intraoperative mean bleeding volume was 700 ml (range, 300-1 500 ml). All the incisions healed by level 1 classification, and no incisions infection and sciatic nerve injury occurred. The patients included in the study have been followed up for at least one year and the imaging data was intact, the mean follow-up time was 19 month (range, 12-26 month). The fracture reduction was evaluated according to the Matta score: 16 cases were anatomical reduction, 3 cases were satisfactory reduction, 2 cases were unsatisfactory reduction, the satisfactory rate of reduction was 90.5% (19/21); the modified Merle D'Aubigné-Postel score at 3 month was 13.0±2.2 (range, 9-16), 6 month was 15.8±2.4 (range, 10-18) and last follow up was 17.0±1.8 (range, 13-18), respectively; the difference was statistically significant ( F=15.38, P < 0.001). At the last follow-up, 15 cases were excellent, 3 cases were good and 3 cases were fair, the total excellent and good rate was 85.7% (18/21). One case developed symptoms of sciatic nerve injury after operation, but the symptoms resolved after treating with neurotrophic drug by 6 months. 2 cases developed arthritis related pain after operation, receiving symptomatic treatment with oral painkillers. During the follow-up period, no complications such as plate broken and screw loosen occurred. Conclusion:The use of an integrative anatomical plate for treating posterior wall/column fractures of acetabulum achieved satisfactory fixation and postoperative functional recovery.
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Objective:To investigate the advantages and disadvantages and clinical effects of integrated acetabular quadrilateral surface buttress plate in the treatment of acetabular both column fractures.Methods:From September 2017 to March 2019, 14 patients with acetabular both column fractures were treated with integrated quadrilateral acetabular buttress plate and were followed up. The clinical data were retrospectively analyzed. There were 10 males and 4 females with an average age of 53.2 years (range, 26-75 years). Fracture classification were both column fractures according to the Letournel-Judet classification system, including 11 cases of combined posterior wall without posterior dislocation. The time from injury to operation was 8-19 days, with an average of 10.3 days. All operations were performed with a supra-ilioinguinal approach. After satisfactory reduction, the integrated acetabular quadrilateral surface buttress plate was used to fix the anterior and posterior column and quadrilateral fractures at the same time. After operation, Matta criteria was used to evaluate the quality of fracture reduction on postoperative images, and modified Merle d'Aubigné-Postel score to evaluate hip joint function.Results:The average operation time was 180 min (range, 120-320 min), and the intraoperative average blood loss was 980 ml (range, 700-1 600 ml). Operations were performed successfully with none intraoperative reshaping conducted, and the plate could fit into the bone surface well. All 14 patients were followed up with an average of 15.6 months (range, 9-20 months). During the follow-up, all fractures healed with an average of 3 months (range, 2.5-5 months). The reduction quality evaluated by the Matta criteria were 7 anatomical, 5 satisfactory, and 2 unsatisfactory, with an excellent and good rate of 85.7% (12/14). The hip joint function at the last follow-up was in accordance with the modified Merle d'Aubigné-Postel score was 12-18 points, with an average of 16.9 points, of which 8 excellent, 4 good, and 2 fair. The excellent and good function rate was 85.7% (12/14). During the operation, 1 patient had a rupture of about 1 cm of the peritoneum during the separation of the spermatic cord, which was immediately sutured and repaired. One patient had obturator nerve paralysis after the operation, without special treatment, and the paralysis symptoms were relieved during the 6th-month follow-up. There were no other operation-related complications.Conclusion:For both-column fractures characterized by central dislocation of the femoral head, the integrated acetabular quadrilateral buttress plate can simultaneously fix the anterior and posterior columns and quadrilateral surface at the same time. Satisfactory reduction and functional outcomes could be achieved by the novel plates.
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Objective:To observe the effects of static 70° head-up tilted standing and of repeated body repositioning on hemodynamics in healthy young and middle-aged persons.Methods:The hemodynamics of 24 middle-aged and 23 younger persons were studied. Both groups were requested to perform static 70° head-up tilted standing and to repeatedly change their body position from 0° to 70° of tilt at a velocity of 1°/second for ten minutes in a random order. Before, between and after each test the subjects rested supine for ten minutes. Hemodynamic variables and blood pressure were recorded non-invasively.Results:The average heart rate (HR) increased significantly in both groups when rising from supine to the testing positions. In 70° tilted standing the average HR of the youth group, 84.0±9.5bpm, was significantly higher than that in the other position and that of the middle-aged group in the same position. The average HR of the middle-aged group in 70° tilted standing was also significantly higher than in the other position. Among the middle-aged group, the average stroke volume (SV) in the testing positions was significantly lower than when resting. Significant differences were observed in the average diastolic blood pressure (DBP) between the testing and rest positions for both groups, with the average DBP of the middle-aged group significantly higher than that of the youth group in all three positions. Among the youth group, the average SV, CO and systolic blood pressure (SBP) of the males were significantly higher than among the females in all of the different body positions.Conclusions:Young persons mainly rely on an increased heart rate to maintain cardiac output while middle-aged participants appear to achieve this through increased peripheral resistance. Repeated position changes have less impact on hemodynamics than 70° inclined standing, making it a safer and more stable training method. However, the long-term effects of such intervention need to be confirmed in further studies.
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The ideal scaffold material can reconstruct the morphology, structure and function of tissues and organs. Thus, it has received extensive attention in the field of tissue engineering. With the rapid development of the theories and technologies of naturally-derived biomaterials, it has gradually become a research hotspot in the field of regenerative medicine. Natural biomaterials have high bionics, good biocompatibility and a wide range of sources. Thus, they are very suitable to be used as scaffolds for tissue engineering. According to ingredients and source of raw materials, they can be roughly divided into protein-based biomaterials (collagen, gelatin, silk and fibrin), carbohydrate-based biomaterials (cellulose, chitin/chitosan, alginate and agarose), glycosaminoglycans (hyaluronic acid, chondroitin sulfate) and decellularized extracellular matrix (amniotic membrane, small intestinal submucosa, tendons). Different scaffold materials have unique natural structures and properties. Protein-based biomaterials can affect cell migration and differentiation through polymerization to form a network structure. They can be made into stents alone or used with other synthetic materials based on certain mechanical properties. Carbohydrate biomaterials can carry a large amount of liquid due to their high specific surface area. However, their mechanical properties are poor. Therefore, it is often used in the form of gel with other materials to control the release of cells and growth factors in tendon tissue engineering. Regularly, the anti-inflammatory, viscoelastic, lubricating and highly hydrating properties of glycosaminoglycan biomaterials can be combined with synthetic materials to increase their biocompatibility and hydrophilicity. Compared with the above materials, the decellularized extracellular matrix not only has a more similar extracellular structure and nutrients, but also has certain mechanical properties. Therefore, it can better reconstruct the morphology, structure and function of tissue and organ lesions. Ultimately, the above materials have been paid more and more attention in tissue engineering. The ingenious combination of different materials makes the repair of tendons show better results. In future, naturally-derived biomaterials could have broader clinical prospects and application value.
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Objective:To evaluate the effect of dexmedetomidine-based anesthesia on intestinal barrier function in the patients with acute intestinal obstruction.Methods:Ninety-four patients with acute intestinal barrier obstruction, aged 33-81 yr, weighing 48-80 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, were divided into 2 groups ( n=47 each) using a random number table method: routine anesthesia group (group R) and dexmedetomidine-based anesthesia group (group D). In group D, dexmedetomidine was intravenously injected in a loading dose of 1 μg/kg at 15 min before induction of general anesthesia followed by an infusion of 0.5 μg·kg -1·h -1 until 30 min before the end of operation.Before infusing the loading dose of dexmedetomidine, at 1 day after surgery, at 3 days after surgery, and at 7 days after surgery, peripheral venous blood samples were collected to measure the concentrations of diamine oxidase, D-lactic acid, bacterial endotoxin, tumor necrosis factor-α and interleukin-6.The occurrence of postoperative complications, anal exhaust time and average length of hospital stay were recorded. Results:Compared with group R, the concentrations of diamine oxidase, D-lactic acid, bacterial endotoxin, tumor necrosis factor-α and interleukin-6 were significantly decreased at 1 and 3 days after surgery, anal exhaust time and average length of hospital stay were shortened, and the requirement for respiratory cycle support and total incidence of complications were decreased in group D ( P<0.05). Conclusion:Dexmedetomidine-based anesthesia can improve intestinal barrier function to a certain extent in patients with acute intestinal obstruction.
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Objective To observe the efficacy of percutaneous transhepatic biliary drainage (PTBD) combined with transarterial chemoembolization (TACE) in treatment of malignant obstructive jaundice, and to evaluate its application value in clinic. Methods A total of 82 patients with malignant obstructive jaundice who received PTBD from January 2017 to January 2019 in Taiyuan Central Hospital were collected. The patients were divided into the experimental group who received TACE (41 cases) and the control group who could not receive TACE (41 cases) after PTBD. Clinical symptoms, liver function, tumor markers, drainage tube patency rate and survival time of the two groups were compared before and after the treatment. T-test and chi-square test were used for statistical analysis, and Kaplan-Meier method was used for survival analysis. Results A total of 93 drainage tubes were placed in 82 patients, and 109 TACE treatments were performed in the experimental group. PTBD and TACE both had successful results. After PTBD, 72 patients felt jaundiceand obvious alleviation of other clinical symptoms. There were no serious complications after PTBD and TACE. Postoperative follow-up results showed that compared with the total bilirubin (TBIL) [(269±113)μmol/L], the direct bilirubin (DBIL) [(159 ±74) μmol/L], alanine transaminase (ALT) [(118 ±40) U/L] and aspartate aminotransferase (AST) [(111±55) U/L] before the operation, the TBIL [(46±11)μmol/L], DBIL [(28±10)μmol/L], ALT [(35±12) U/L] and AST [(33±12) U/L] in the experimental group were decreased significantly 3 months after the operation, and the differences were statistically significant (all P<0.05). TBIL [(48±9)μmol/L], DBIL [(25±10) μmol/L], ALT [(32±9) U/L] and AST [(30±12) U/L] in the control group were decreased significantly compared with TBIL [(291±114)μmol/L, DBIL [(171±66)μmol/L], ALT [(129±54) U/L] and AST [(114±43) U/L] before the operation, and the differences were statistically significant (all P< 0.05). There was no significant difference in liver function between the two groups before the operation and 3 months after the operation (both P>0.05). The level of carbohydrate antigen-199 in the experimental group at 6 months after PTBD was lower than that in the control group [(426 ±136) U/ml vs. (569 ±204) U/ml; t = 19.457, P < 0.05]. There were statistical differences in the patency rate of the both groups at 6, 9 and 12 months after PTBD (all P< 0.05). The median survival time in the experimental group was longer than that in the control group (310.4 d vs. 234.5 d; χ2= 12.678, P< 0.05). Conclusion The effect of PTBD in patients with malignant obstructive jaundice is obvious. The combination with TACE after PTBD can prolong the survival of patients and it is worthy of clinical application.
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Objective@#To investigate the clinical effect of the combination of distal subcutaneous buried suture, to reduce local tension, and electron irradiation for the treatment of keloid.@*Methods@#From May 2014 to July 2016, nine female patients with recurrent keloid in torso were treated by above method. After eligibility was confirmed, surgery was performed to completely excise the keloid. An extensive subcutaneous segregation was made around the incision. The 4-0 PDS Ⅱ sutures were buried in the subcutaneous layer, 1.5 cm from the edges of incision, 1 cm apart from each other, and were knotted from both ends of the incision to the center. The normal skin on both sides of the incision were pulled toward the center, and completely relaxed without tension. An interrupted subcutaneous suture was made with a 4-0 Coated VICRYL absorbable suture, and a continuous intradermic suture was made using a 5-0 Coated VICRYL absorbable suture. Superficial electron irradiation was implemented 10-22 h postoperatively. The dose of radiation was 4 Gy each time, with the frequency of 4-5 times in 4-7 days, once a day, and the total dose was up to 16-20 Gy.@*Results@#The average follow-up was 15 months (12-18 months). Based on the three-stage classification system formulated by Dr. Cai, an asymptomatic flat and soft scar without recurrence up to 12 months was classified as cured (excellent). All the patients in this series met the criterion of cure.@*Conclusions@#The distal subcutaneous buried suture technique, pulling bilateral normal skin toward the center with a PDS Ⅱ suture, could completely relax the skin around the incision, and maintain a prolonged tension-free state, combination therapy of electron irradiation and surgery may reduce the inflammation during the healing process, and result in a dramatic inhibition of the recurrent of keloids after surgery.
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Abjective To observe the influence of moxibustion on the bone metabolism of persistent vegetative state patients. Methods A total of 60 patients with persistent vegetative state were divided randomly into the treatment group and control group, 30 in each. Both groups were treated with routine therapy, and the patients used moxibustion on the acupoints of zhongwan, xiawan , qihai and guanyuan. The treatment lasted 12 weeks. The changes of T-lymphoctyte subgroups, serum immunoglobulin were tested and compared before and 12th week after treatment. Result After 12th week treatment, the BMD of distal radius (0.563 ± 0.205 g/cm2 vs. 0.451 ± 0.114 g/cm2, t=2.615), the second lumbar vertebra (0.596 ± 0.108 g/cm2 vs. 0.533 ± 0.127 g/cm2, t=2.069) and the femoral neck (0.567 ± 0.214g/cm2 to 0.463 ± 0.163g/cm2, t=2.117) in the treatment group were significantly higher than those in the control group (Ps＜0.05). The PTH (6.41 ± 0.56 pmol/L vs. 6.72 ± 0.42 pmol/L, t=0.018), CT (217.48 ± 57.35 ng/L vs. 228.46 ± 52.44ng/L, t=0.012) and BGP (9.16 ± 1.57 g/L vs. 10.37 ± 2.37 g/L, t=0.023) in the treatment group were significantly higher than those in the control group (Ps＜0.05). Conclusions Moxibustion can help to treat the bone metabolism of persistent vegetative state patients and prevent the osteoporosis.
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Objective:To investigate the therapeutic effect of stroke patients received rehabilitation treatment at different medical units in the Rehabilitation Medical Association.Method:Totally 183 stroke patients were recruited from October 12,2012 to February 5,2016 by Shenzhen Rehabilitation Medical Association(SRMA).SRMA consists of 4 members,including the Second People's Hospital of Shenzhen,Shenzhen Nan'ao People's Hospital,Shenzhen Baoxing Hospital and Community Healthcare Center in Futian District,which belong to tertiary hospital,secondary hospital,and primary healthcare unit,respectively.According to the time of onset of stroke,all the patients were divided into recovery phase or sequelae phase.The rehabilitation facilities were standardized.All patients received rehabilitation treatment for 4 weeks,which included functional rehabilitation training of limb,functional electrical stimulation training,activities of daily living training.Fugl-Meyer Assessment(FMA),balance subscale of the Fugl-Meyer test(FMB),National Institute of Health Stroke Scale(NIHSS) and modified Barthel Index(MBI) before and after rehabilitation treatment were used to evaluate the effects.Result:The scores of FMA,FMB,NIHSS and MBI were significantly improved in all the groups after rehabilitation treatment(P ＜ 0.05).There was no significant difference in all assessments among the groups(P＞ 0.05).Conclusion:Based on the standardized rehabilitation treatment programs,the stroke patients come from the members of Rehabilitation Medical Association can achieve homogeneous effects after rehabilitation treatment.
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Objective@#To analyze the risk factors for metastasis of lymph nodes between sternocleidomastoid and sternohyoid muscle (LNSS) in papillary thyroid cancer (PTC).@*Methods@#Papillary thyroid cancer patients with clinically positive lateral lymph node metastasis (cN1) who underwent surgery including LNSS dissection between May 1, 2013 and May 31, 2016 at the Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center were retrospectively studied. Logistic regression analysis was performed to evaluate possible clinicopathological factors related to LNSS metastasis.@*Results@#In 85 patients, 54 patients (63.5%) showed LNSS in their surgical specimen, and 20 patients (23.5%) had pathologically positive LNSS metastasis. Patients with LNSS showed preoperatively higher levels of serum thyroid stimulating hormone (TSH) and thyroid peroxidase antibody (TPO-Ab) compared to patients only with fibrofatty tissues between sternocleidomastoid and sternohyoid muscle (P<0.05), and they also displayed a higher proportion of multifocality in ipsilateral thyroid lobe (P<0.05). Multi-factor analysis indicated that LNSS metastasis was correlated with original tumor size (OR=1.819, 95%CI 1.050-3.850, P=0.002) and Level Ⅳ lymph node metastasis (OR=2.190, 95%CI 1.132-2.334, P=0.005). Furthermore, the number of positive LNSS was tightly correlated to that of level Ⅳ lymph node metastasis(P<0.05).@*Conclusion@#LNSS metastasis is occult but not quite rare in PTC. Patients with extensive lymph node metastasis in Level Ⅳhave a higher risk for metastasis of LNSS.
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The da Vinci Surgical System has developed and great progress has been made recently in surgery. Despite lack of applications in tumors of head and neck, its advantages, such as minimally invasive procedure and rapid recovery, show great prospects. In this article, we reviewed the surgical method, indication, advantages and prospects of its application in tumors of head and neck.
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Objective: To study therapeutic effect of personalized aerobic exercise based on exercise load test assessment on heart function and psychological state in patients with acute myocardial infarction (AMI). Methods: According to random number table, a total of 80 AMI patients during recovery period were randomly and equally divided into routine treatment group (n=40, received routine drug therapy) and exercise group (n=40, received personalized aerobic exercise based on exercise load test assessment on the basis of routine treatment group). Serum levels of high-sensitivity cardiac troponin I (hs-cTnI) and creatine kinase isoenzyme MB (CK-MB), and left ventricular ejection fraction (LVEF), stroke volume (SV), left ventricular fractional shortening (LVFS), ventricular wall thickening rate (△T), motion amplitude of interventricular septum (AIS), and scores of self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were compared between two groups before and after 12-week intervention. Results: Compared with before intervention, there were significant reductions in serum levels of hs-cTnI and CK-MB, and scores of SAS and SDS; and significant rise in LVEF, SV, LVFS, △T and AIS in both groups after 12-week intervention (except LVEF of routine treatment group), P<0.05 or <0.01; compared with routine treatment group, there were significant reductions in serum levels of hs-cTnI [(9.31±1.04) ng/L vs. (5.89±0.72) ng/L] and CK-MB [(11.34±1.25) U/L vs. (8.41±1.01) U/L],in scores of SAS [(51.34±6.54) scores vs. (42.32±5.29) scores] and SDS [(50.23±6.92) scores vs. (43.86±6.03) scores];and significant rise in LVEF [(57.12±6.67)% vs. (62.32±7.34)%], SV [(62.45±7.13) ml vs. (69.18±7.84) ml], LVFS [(23.93±2.96)% vs. (28.45±3.12)%], △T [(28.51±3.41)% vs. (34.52±4.87)%] and AIS [(9.56±1.02) mm vs. (12.45±1.46) mm] in exercise group, P<0.05 or <0.01. Conclusion: Personalized aerobic exercise based on exercise load test assessment can reduce myocardial cell injury, improve cardiac function, relieve negative emotions and promote patients’ rehabilitation rapidly.
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Objective To explore the clinical effects of laparoscopic combined with gastroscopic surgery for the gastric stromal tumors (GSTs) from the muscularis propria.Methods The clinical data of 25 patients with GSTs from the muscularis propria who were admitted to the Qianfoshan Hospital Affiliated to Shandong University between January 2011 and January 2014 were retrospectively analyzed.Patients received the general anaesthesia by endotracheal intubation.The pneumoperitoneum was done by an arc incision of 0.5 cm above margin of the umbilical cord and then laparoscopy was placed for exposing and gastroscopy was placed for confirming the location of the tumor.A laparoscope was placed in the cavity via the trocar at the navel,and the other two trocars penetrated both the abdominal and stomach walls.With gastroscopic monitoring,the operation was carried out in the gastric lumen using laparoscopic instruments and the tumor was resected.The tumor tissue was removed orally using a gastroscopic basket,and puncture holes and perforations were sutured using titanium clips.The proton pump inhibitor and antibiotics were used as the conventional therapy for 3 days,while adjuvant therapy with a usage of imatinib was applied to patients who were confirmed with the high-risk GSTs by pathological examination after tumors resection,and the other patients did not receive adjuvant therapy.Gastroscopic reexamination was done every 3 months within postoperative 1 year and then every 6 months after 1 year.Abdominal CT reexamination was done every 6 months within postoperative 1 year and then every 1 year after 1 year.The followup was done till December 2014.Results All the 25 patients received successfully modified laparoscopic combined with gastroscopic surgery without conversion to open surgery and postoperative complication.The operation time,volume of intraoperative blood loss,diameter of tumor,duration of postoperative abdominal pain and duration of hospital stay were (79 ± 4) minutes,(28 ± 3) mL,(2.6 ± 0.3) cm,(2.8 ± 0.3) days and (6.3 ± 0.3) days,respectively.GSTs were confirmed by postoperative pathological examination.The mitotic count was (3.3 ± 0.3) /50 HPF and reached R0 resection.Extremely low risk was detected in 3 patients,low risk in 19 patients,intermediate risk in 3 patients and no high risk was detected.Two of 3 patients with intermediate risk took the medicines following instructions without the adverse drug reaction,and 1 of 3 patients refused to take the medicines due to low income.All the patients were followed up for 12-36 months without the recurrence or metastasis of tumors.Conclusion Modified laparoscopic combined with gastroscopic surgery is feasible and effective for the treatment of gastric stromal tumors (GSTs) from the muscularis propria.
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Objective:To explore effects of frustration situation,resilience and positive music on attentional bias by a behavioral experiment.Methods:Totally 60 participants were chosen from 650 college students according to their scores in Connor-Davidson Resilience Scale (CD-RISC).Then,a 2(resilience,high/low)×3(experimental treatment,no frustration/frustration with positive music /frustration without any background)×2(vocabulary,posi-tive /passive)mixed design experiment was conducted to investigate the attentional bias of participants in emotional Stroop paradigm.Results:Reaction times to passive vocabulary were different significantly in three frustration situa-tions(P <0.01).Interaction of resilience and frustration on reaction time to positive vocabulary was significant (P<0.01).Among the participants with low resilience,reaction time to positive vocabulary in the situation without frustration or the frustration situation with positive music was longer significantly than that in the frustration situa-tion without any background [(476.3 ±85.6)vs.(456.0 ±54.0)vs.(427.1 ±61.1),P <0.05].Among the par-ticipants with high resilience,reaction time to positive vocabulary in the frustration situation without any background was longer than that in the situation without frustration [(472.1 ±82.9)vs.(432.4 ±53.2),P <0.05].Conclu-sion:It suggests that individuals may have obviously attentional bias to negative stimulus in frustration situation,and effects of resilience and positive music on attentional bias in situation may be obvious.